Eating Disorders: Myths and Realities

Many people know a little bit about eating disorders, but usually a lot of what people think they know turns out to be flat wrong. Why? There are a ton of misconceptions out there, driven by movies and TV programs where the producers may be aware of the epidemic but do not devote the research dollars needed to portray eating disorders meaningfully.

It’s easier to describe people with eating disorders as vain, attention seeking, or willful than to delve into the complex emotional world that drives these behaviors. These myths work their way into the general population, and it wouldn’t be surprising if you believe them too, even if only an unconscious level.

Myth: Only women get eating disorders.

Reality: The National Eating Disorders Association estimates that 10 percent of people receiving treatment for eating disorders are male (American Addiction Centers 2018). Unfortunately, many have interpreted this as meaning only 10 percent of people with eating disorders are male (Anorexia Nervosa and Related Eating Disorders 2018). However, the number of men suffering is much higher, closer to 25 to 40 percent of the general population, according to Hudson et al. (2007).

This percentage may be even greater, as men are much less likely to seek treatment for eating disorders. There’s a huge stigma surrounding the idea of having a “girl’s disease,” so men often don’t get treatment for it. Also, disordered eating may look very different for males, who have different “ideal” body types manufactured and promoted to them.

Myth: Only teenagers get eating disorders.

Reality: Eating disorders in midlife are increasingly common and growing at an alarming rate. The National Eating Disorders Association reports that 13 percent of women over fifty have eating disordered symptoms (Gagne et al. 2012). There is less information available on men in midlife for the reasons already stated, but I would bet my bottom dollar that eating disorders are much, much more common in middle-aged men than people think.

Midlife has unique stressors, such as bearing and raising children and supporting aging parents, work stress, and household responsibilities. In the current cultural climate, ideas like “fifty is the new thirty” increase the pressure to maintain a certain body type during this stressful time, - at the very same time that the body slows its metabolism, changes its chemistry, and responds differently to food and exercise. For many women, having children can change the body significantly as well. For men, lowered testosterone contributes to similar changes. Add to this all of the cultural messages about what it means to become “old,” and you have a recipe for disaster.

Eating disorders strike without care to gender, creed, race or nationality. The only difference is who gets diagnosed and treated.

Eating disorders strike without care to gender, creed, race or nationality. The only difference is who gets diagnosed and treated.

Myth: Only white people get eating disorders.

Reality: It is true that different races and ethnicities may have different “body ideals”, and that a curvier body may be more acceptable in some cultures than others. Many people think that this makes certain groups somehow immune to eating disorders, but that is not the case at all. Eating disorders are not only about body shape and size. They often evolve as ways of managing overwhelming stress, often including negative thoughts and feelings about oneself. In our dominant culture, which pushes not only a thin ideal (the idea that thin is better than not thin) but also a white ideal, these thoughts and feelings might even be much worse among some people of color, who experience daily racism and discrimination. A 2013 review of studies focusing on this topic showed both that ethnic minorities were less likely to seek treatment for disordered eating and that referrers were significantly less likely to send ethnic minorities to specialists in disordered eating (Hudson et al. 2007).

Myth: Eating disorders are only about food.

Reality: An eating disorder is about using food and the body as a way to cope with deep and complex emotional issues. The exact psychological reason behind disordered eating behavior is different for everyone. It may be about numbing anger or coping with shame. Sometimes it’s a way to try to feel good enough when that feeling is hard to find. The rules of the eating disorder often feel to the sufferer like they were written in stone—it really doesn’t seem to be okay to eat after a certain time of night, to have seconds, or to stop exercising before the clock has reached whatever-o’clock. Following these food rules is done for deep psychological reasons.

Myth: Eating disorders are not dangerous.

Reality: Reality: The unfortunate reality is that eating disorders can be quite dangerous. The behaviors associated with these diseases are very hard on the body and can have extremely serious consequences. Restriction, or not eating enough to fuel the body’s needs, can lead to slow heart rate, low blood pressure, and even heart failure. Osteoporosis, or brittle bones, is often caused by not having enough calcium. Dehydration is quite common with restriction and may lead to kidney issues. Malnutrition can also cause further mental health problems or make existing ones worse.

Purging can also have severe health consequences, including electrolyte imbalances, which can lead to heart failure. If a person is purging by vomiting, the esophagus often becomes inflamed and may even rupture. If someone is using laxatives, the gastrointestional tract can stop functioning properly and the person can become severely dehydrated (again, possible kidney failure). Peptic ulcers and pancreatitis are associated with purging as well. The health consequences of bingeing are largely those associated with clinical obesity, such as high cholesterol, high blood pressure, and type 2 diabetes. In addition, the uncontrolled nature of the binge may lead to gastric rupture, a tear in the stomach that can potentially be fatal.

Myth: Eating disorders do not require professional treatment.

Reality: Because eating disorders are so complex—involving emotions, behaviors, and physical consequences—attempting to deal with an ED on your own can be difficult and potentially harmful. It is absolutely vital to work with a team who knows the terrain, often a psychotherapist, dietitian, medical doctor, and perhaps a psychiatrist . Attempting recovery on your own after a prolonged period of restriction can even be dangerous, because the body may have difficulty adjusting to having normal amounts of food again. Having food intake monitored by a professional is important to make sure that recovery doesn’t put the body through more trauma.

Additionally, as previously discussed, the emotional factors involved in eating disorders are multifaceted and deep. A spouse, boyfriend, or girlfriend can never be the only support for someone working through these types of issues—you are just too close to the problem. Psychotherapists who specialize in eating disorders are trained to know what to look for and what questions to ask. They also bring value as an objective outside party without the same type of stake in the outcome. Without treatment, up to 20 percent of people with serious eating disorders die. With treatment, that number falls to 2 to 3 percent (Powers et al. 2012). Luckily, effective help is available. Reach out to schedule an appointment or ask for help finding a provider near you.

American Addiction Centers. 2018. “Finding the Best Anorexia, Bulimia and Eating Disorder Treatment for Men.” Retrieved from https://www.bulimia.com/topics/men/.

Anorexia Nervosa and Related Eating Disorders. 2018. “Statistics: How Many People Have Eating Disorders?” Retrieved from https://www.anred.com/stats.html.

Gagne, D. A., A. Von Holle, K. A. Brownley, C. D. Runfola, S. Hofmeier, K. E. Branch, and C. M. Bulik. 2012. “Eating Disorder Symptoms and Weight and Shape Concerns in a Large Web-Based Convenience Sample of Women Ages 50 and Above: Results of the Gender and Body Image (GABI) Study.” International Journal of Eating Disorders 45 (7), 832–44.

Hudson, J. I., E. Hiripi, H. G. Pope, and R. C. Kessler. 2007. “The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication.” Biological Psychiatry 61 (3): 348–58.

Powers, M. A., S. Richter, D. Ackard, S. Gerken, M. Meier, and A. Criego. 2012. “Characteristics of Persons with an Eating Disorder and Type 1 Diabetes and Psychological Comparisons with Persons with an Eating Disorder and No Diabetes.” International Journal of Eating Disorders 45 (2): 252–56.

What is bulimia?

Bulimia Nervosa

Bulimia is characterized by two main behaviors- binging and purging. Purging is an attempt to rid the body of calories. Many people associate vomiting with bulimia, and in fact this is one of the more common forms that purging can take. Those who purge through vomiting often do it immediately after a binge, but sometimes a significant amount of time can lapse between binging and purging.

What many people don’t know is that purging can also take other forms - some people may exercise excessively, fast for a period of time, or take diuretics or laxatives. For some people purging may feel like a “necessary evil” in order to relieve guilt about binging, but others find the sense of relief and emptiness that they gain from purging a motivation in itself.

Another part of the diagnosis is that a person’s “self-evaluation is unduly influenced by body shape and weight”. For someone with any eating disorder, weight gain is associated with a terrible spiral of guilt, shame, and unworthiness. It can be difficult to understand from the outside why somebody would be so preoccupied with their body shape and size, but it is enough to know that your partner’s weight likely symbolizes much more to them. A person must also be able to maintain a minimum healthy weight in order to qualify for the bulimia diagnosis (although the person may not see their weight as healthy), or else anorexia, binge-purge type, would be a more appropriate label. According to the National Association of Anorexia Nervosa and Associated Disorders, 1.5% of American women will suffer from bulimia at some point in their lifetimes.

 

 

Bulimia is an eating disorder characterized by obsession over weight and tendency to eat food and then get rid of it in some manner.

Bulimia is an eating disorder characterized by obsession over weight and tendency to eat food and then get rid of it in some manner.

Common Behaviors Associated with Purging/Bulimia:

  • Anger, irritability and/or anxiety if unable to purge after binging
  • Excusing oneself to the bathroom immediately after eating
  • Running the shower or faucet while in the bathroom
  • Spending an unusual amount of time in the bathroom
  • Returning with watery, red eyes after suspected purging
  • Spending hours at the gym
  • Exercising even when injured
  • Fasting or dieting in order to compensate for food eaten
  • Hiding boxes of laxatives, diuretics, or enemas
  • Obsessing over weight, body shape or size